Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients

Dokai, Toshiyuki; Nagashima, Hideki; Nanjo, Yoshiro; Tanida, Atsushi; Teshima, Ryota

doi:10.1007/s00402-011-1449-4

Cited by 41 publications

(57 citation statements)

References 30 publications

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“…Diabetic patients demonstrated poorer return of lower extremity neurologic function (sensory and motor) than nondiabetic patients [65] . Suboptimal glycemic control was associated with inferior outcomes as higher levels of preoperative Hgb A1c were associated with poorer rates of neurologic recovery [65] .…”

Section: Cervical Surgerymentioning

confidence: 86%

“…These patients underwent decompression and fusion for cervical myelopathy [64] . The authors found that uncontrolled DM was an independent risk factor for poorer outcomes after cervical fusion A retrospective controlled study of outcomes from the surgical treatment of cervical myelopathy reviewed a group of patients with DM and compared them to a cohort of patients without DM [65] . Diabetic patients demonstrated poorer return of lower extremity neurologic function (sensory and motor) than nondiabetic patients [65] .…”

Section: Cervical Surgerymentioning

confidence: 99%

“…The authors found that uncontrolled DM was an independent risk factor for poorer outcomes after cervical fusion A retrospective controlled study of outcomes from the surgical treatment of cervical myelopathy reviewed a group of patients with DM and compared them to a cohort of patients without DM [65] . Diabetic patients demonstrated poorer return of lower extremity neurologic function (sensory and motor) than nondiabetic patients [65] . Suboptimal glycemic control was associated with inferior outcomes as higher levels of preoperative Hgb A1c were associated with poorer rates of neurologic recovery [65] .…”

Section: Cervical Surgerymentioning

confidence: 99%

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Diabetes and its negative impact on outcomes in orthopaedic surgery

Wukich

2015

WJO

110

103

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An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.

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Section: Cervical Surgerymentioning

confidence: 86%

Section: Cervical Surgerymentioning

confidence: 99%

Section: Cervical Surgerymentioning

confidence: 99%

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Diabetes and its negative impact on outcomes in orthopaedic surgery

Wukich

2015

WJO

110

103

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show abstract

“…This disparity between clinical and radiological parameters may be related to factors independent of radiology, such as preoperative functional status, symptom duration, and concurrent lumbar spine or peripheral nerve disease as well as parameters that are difficult to quantify, such as patient motivation and expectation, glycemic control, and nicotine dependence. 2,8,12,23,36 The presence of a T1-weighted hypointensity is probably the single best predictor of outcome on preoperative imaging, 3,6,10,22,32,33 but these changes are relatively uncommon. The exact prognostic relevance of the quality of T2-weighted ISI changes in the absence of T1-weighted changes remains elusive.…”

Section: Prognostic Relevance Of T2-weighted Isimentioning

confidence: 99%

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

Sarkar¹,

Turel²,

Jacob

et al. 2014

SPI

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Object T2-weighted intramedullary increased signal intensity (ISI) on MRI in patients with cervical spondylotic myelopathy (CSM) appears to represent a wide spectrum of pathological changes that determine reversibility of cord damage. Although sharp T2-weighted ISI on preoperative imaging may correlate with poorer surgical outcomes, there are limited data on how these changes progress following surgery. In this study, the authors characterized pre-and postoperative ISI changes in patients undergoing surgery for CSM and studied their postoperative evolution in an attempt to quantify their clinical significance. Methods The preoperative and postoperative MR images obtained in 56 patients who underwent oblique cervical corpectomy for CSM were reviewed, and the ISI was classified into 4 subtypes based on margins and intensity: Type 0 (none), Type 1 (“fuzzy”), Type 2 (“sharp”), and Type 3 (“mixed”). The locations of the ISI were further classified as focal if they represented single discrete lesions, multifocal if there were multiple lesions with intervening normal cord, and multisegmental if the lesions were continuous over more than 1 segment. The maximum craniocaudal length of the ISI was measured on each midsagittal MR image. The Nurick grade and Japanese Orthopaedic Association (JOA) score were used to assess clinical status. The mean duration of follow-up was 28 months. Results T2-weighted ISI changes were noted preoperatively in 54 patients (96%). Most preoperative ISI changes were Type 1 (41%) or Type 3 (34%), with a significant trend toward Type 2 (71%) changes at follow-up. Multi-segmental and Type 3 lesions tended to regress significantly after surgery (p = 0.000), reducing to Type 2 changes at follow-up. Clinical outcomes did not correlate with ISI subtype; however, there was a statistically significant trend toward improvement in postoperative Nurick Grade in patients with a > 50% regression in ISI size. In addition, patients with more than 18 months of follow-up showed significant regression in ISI size compared with patients imaged earlier. On logistic regression analysis, preoperative Nurick grade and duration of follow-up were the only significant predictors of postoperative improvement in functional status (OR 4.136, p = 0.003, 95% CI 1.623–10.539 and OR 6.402, p = 0.033, 95% CI 1.165–35.176, respectively). Conclusions There is a distinct group of patients with multisegmental Type 3 intramedullary changes who show remarkable radiological regression after surgery but demonstrate a residual sharp focal ISI at follow-up. A regression of the ISI by > 50% predicts better functional outcomes. Patients with a good preoperative functional status remain the most likely to show improvement, and the improvement continues to occur even at remote follow-up. The clinical relevance of the quality of the T2-weighted ISI changes in patients with CSM remains uncertain; however, postoperative regression of the ISI change is possibly a more important correlate of patient outcome than the quality of the ISI change alone.

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“…Some are also limited by retrospectively collecting their data, having brief follow up periods, or failing to take into account the severity of diabetes. Some studies report that diabetes is associated with worse outcomes following the surgical treatment of CSM, 14,15,[16][17][18] while others report no association. 16,19,20 DM is attributed with complications of microvasculature that can lead to cardiovascular, ophthalmic, renal, and peripheral vascular disease.…”

Section: Introductionmentioning

confidence: 99%

Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy

et al. 2017

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Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients

Abstract: Diabetic patients experienced benefits from ELAP similar to non-diabetic patients. A negative correlation between RR and preoperative HbA(1c) level suggests that strict blood sugar control is recommended before surgery.

Cited by 41 publications

References 30 publications

Diabetes and its negative impact on outcomes in orthopaedic surgery

Diabetes and its negative impact on outcomes in orthopaedic surgery

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy

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